pulmonary embolism (PE) presenting as seizure

22 Jul

Just to scare you a little:

You next patient is rolling in to the ER seizing, and that 02 sat has just been a bit iffy: is it a poor waveform because they’re twitching, is there an airway issue there, or is there something else going on?

 

HYPOXIA and/or HYPOPERFUSION is bad for brains

massive PE causes transient right ventricular failure, and decreased cardiac output, causing transient global cerebral hypo-perfusion

 

ARTICLE 1:

–case of a young woman who presented to the emergency department with first-time seizureson post-mortem findings, this was found to be a manifestation of PE

 

ARTICLE 2:

case report of 37-year-old woman, admitted for a seizure as the presenting manifestation of pulmonary embolism

review nine additional similar cases reported in the literature since 1945. 

  • Seizures were always generalized tonico-clonic
  • without a past medical history of epilepsy in any case.
  • Tachycardia was noted in nine patients over ten.
  • Prognosis was usually severe leading to death by cardiovascular deficiency in 70% of cases.

 

ARTICLE 3:

50-year-old male with sudden syncope and witnessed seizure activity was discovered to have pulmonary emboli.

Although he denied shortness of breath, d-dimer testing was positive and a ventilation-perfusion scan was positive for bilateral pulmonary emboli; cardiac ECHO also confirmed elevated right ventricular pressures.

 

 

BOTTOM LINE:

give its at the case-report level, this is likely a rare presentation (but probably a bad sign, severity/mortality-wise)

still, keep PE in the back of your mind in the differential for seizure

 

References: article 1; article 2; article 3; picture

 

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